Organization
ST. MARY'S INDEPENDENT LIVING EXTENSIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL PIEPER (EXECUTIVE DIRECTOR)
(770) 279-5115
Entity
Organization
Contact information
Practice address
120 GLOSTER RD NW STE 3, LAWRENCEVILLE, GA 30044-4479
(770) 279-5115
(770) 923-2059
Mailing address
120 GLOSTER RD NW STE 3, LAWRENCEVILLE, GA 30044-4479
(770) 279-5115
(770) 923-2059
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
067-R-0388
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
779876528A
—
GA
05
—
779876528B
—
GA
Enumeration date
04/21/2015
Last updated
04/21/2015
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us